Bay Area Reporter - September 21, 2006
Bob Roehr

Failure to do so will result in appropriations for fiscal year 2008 being allocated under the 2000 reauthorization formula and mandated requirements. That includes use of names-based reporting based on HIV status rather than the current criteria based on cumulative AIDS cases.

The version of the new bill that has moved through the Senate health committee would adversely affect New York and a handful of other states. Senator Hillary Rodham Clinton (D-New York) voted against it in committee and her continued opposition has stalled its consideration by the entire Senate.

One estimate is that New York may lose $27 million in funding for the AIDS Drug Assistance Program. Florida, New Jersey, and Texas also are scheduled for multimillion-dollar hits. San Francisco also is bracing for hits, as is the state as a whole.

That led to tinkering with provisions in the House version of the bill, which was released on September 7. At a September 11 meeting between Hill staffers and AIDS advocates, "congressional staffers urged that media not report on this event," according to Housing Works, an AIDS services and advocacy group in New York City.

"The final bill must address the needs of communities where the rates of new HIV infection are growing rapidly, without undermining the care structures in those communities where the majority of those living with HIV reside," Frank Oldham said at that meeting. He was reading a statement on behalf of a community coalition of eight major AIDS organizations.

Oldham is executive director of the National Association of People With AIDS. The other groups were AIDS Action; the AIDS Alliance for Children, Youth, and Families; Communities Advocating Emergency AIDS Relief; National Alliance of State and Territorial AIDS Directors; National Minority AIDS Council; and Project Inform.

The following day, those groups reiterated their concerns in a letter stating, "We do not support the bill as released on September 7 in its current form." The primary objection is that it would shift funds from traditional centers of the epidemic to areas with emerging new infections.

That led to further tinkering with the bill, a second meeting with AIDS advocates on September 15, and then yet more changes in language over the weekend.

Ryan Cleary, with San Francisco-based Project Inform, said one stumbling point was that the new formula for Title I cities only counted HIV diagnoses made within the last five years and not the total number of people living with HIV in that city.

As an example, both San Jose and Nashville have about 1,500 people living with HIV. But the epidemic is older in San Jose, with only 400 of the cases being diagnosed within the last five years, while the epidemic is much newer and growing in Nashville.

Under the proposed legislation, San Jose would have become ineligible for Title I funds because its caseload was not recent enough. That penalizes cities for effective prevention activities, advocates said. It also ignores the fact that patients who have been in treatment longer often are sicker and require more complex and expensive care.

Cleary said the most recent language creates a "hold harmless" provision that will keep cities with at least 1,500 active cases from losing their Title I funding. It protects three or four California jurisdictions that were at risk of losing that status.

Most of the community coalition members are waiting to see what final language emerges from the Energy and Commerce Committee mark-up on September 20 before deciding whether or not to support the bill.

The AIDS Institute and the Southern AIDS Coalition were among those that did not join in the community coalition.

"While we support most of the legislative changes in the bill, it places unrealistically low funding levels on CARE Act programs for the next five years," said Carl Schmid, director of federal affairs at the AIDS Institute.

"In addition to the low authorization levels that do not provide enough funding to meet growing patient case loads, we are extremely disappointed this new version of the bill provides absolutely no increases next year for the nation's ADAPs," he added.

Schmid said they are reluctantly supporting the bill and are turning their attention to the appropriations committees "to try to find additional new money" to add to the programs.

Housing Works President Charles King said, "No formula distribution is going to resolve the reality of the AIDS crisis until they put enough money in."

Assuming that Ryan White does pass the House, the legislation would then be offered as a substitute amendment for the version awaiting action on the Senate floor.

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